Provider Demographics
NPI:1891046892
Name:DOCTORS MEDICAL CENTER
Entity Type:Organization
Organization Name:DOCTORS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE 1
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA RHESSA
Authorized Official - Middle Name:SENO
Authorized Official - Last Name:OPOLENTISIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-578-1211
Mailing Address - Street 1:3032 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3032 MONTGOMERY LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-7997
Practice Address - Country:US
Practice Address - Phone:209-578-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702167282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital